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Cardiovascular Medicine > Peripheral Arterial Disease > Flashcards

Peripheral Arterial Disease Flashcards

1
Q

List the pulse points of the body that should be palpated during a cardiac examination

A
  1. Radial
  2. Brachial
  3. carotid
  4. Femoral
  5. Popliteal
  6. Posterior tibial
  7. Dorsalis pedis
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2
Q

What is the main cause of chronic limb ischaeia?

A

Atherosclerotic disease of the arteries supplying the lower limb

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3
Q

What are the 2 less common causes of chronic lower limb ischaemia?

A
  1. Vasculitis

2. Buerger’s Diseases

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4
Q

List the 5 main risk factors associated with chronic limb ischaemia

A
  1. Male
  2. Age
  3. Smoking
  4. Hypercholesterolemia
  5. Hypertension
  6. Diabetes
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5
Q

Name the classification system used to stage chronic limb ischaemia

A

The Fontaine classification

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6
Q

Explain each stage of the Fontaine Classification

A

Stage I-Asymptomatic, incomplete blood vessel obstruction

Stage IIA- Mild claudication pain in limb when walking a distance of greater than 200 meters

Stage IIB- Mild claudication pain in limb when walking a distance of less than 200 meters

Stage III (critical)- Rest pain, mostly in the feet

Stage IV (critical)- Necrosis and/or gangrene of the limb

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7
Q

What examination findings might you notice in somebody with chronic limb ischaemia?

A

Ulceration, Pallor & Hair loss in the leg

Differences in temperature, capillary refill, peripheral sensation and pulses between the two legs

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8
Q

What is the first line investigation into chronic limb ischaemia?

A

Duplex scan or CTA/MRIa

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9
Q

What are 2 advantages and 2 disadvantages of a duplex scan?

A

Advantages:

  1. Dynamic
  2. No radiation or contrast

Disadvantages:

  1. Not useful in the abdomen
  2. Operator dependent, time consuming
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10
Q

Name the tests/investigations that can be conducted in patients with suspected chronic limb ischaemia

A

Tests:

  1. Ankle Brachial Pressure Index
  2. Buerger’s test

Investigations:

  1. Duplex scan
  2. CTA/MRIa
  3. Digital subtraction angiography
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11
Q

Describe how the ankle brachial pressure index corresponds to the severity of chronic limb ischaemia

A

Ankle pressure (mmHg) / brachial pressure (mmHg)

> 1 = no symptoms

  1. 95-0.5 = Intermittent claudication
  2. 5-0.3 = Rest pain

<0.2 = gangrene and ulceration

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12
Q

Describe Brueger’s Test

A

Elevate the legs
and look for Pallor & Buerger’s Angle (< 20 degrees severe ischaemia)

THEN

Hang feet over edge of bed and look for: Slow to regain colour & a dark red colour (hyperaemic sunset foot)

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13
Q

What happens during Digital subtraction angiography?

A

Stents are fitted in the damaged vessel

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14
Q

How should patients with chronic limb ischaemia be managed?

A

in the same way as those with coronary artery disease!

  1. Antiplatelets & statins
  2. Target BP. <140/85
  3. Smoking cessation, diabetic control and increased exercise
  4. Open surgery (bypass and/or endarterectomy)
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15
Q

What are the risk factors associated with open surgical management of a patient with chronic limb ischaemia?

A

Bleeding, wound infection, pain, scar, DVT, PE, MI, CVA, LRTI, death, damage to nearby vein, artery, nerve, distal emboli, graft failure

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16
Q

What is the re-intervention rate of patients with chronic limb ischaemia?

A

18.3-38.8%

17
Q

What is the name of the trial which looked at chronic limb ischaemia patient outcomes between angioplasty or surgery?

A

The BASIL trial

18
Q

What were the main findings of the BASIL trial?

A

If short-term results are what matter angioplasty is the likely preferred strategy.

However, in patients with suitable anatomy, vein availability and a reasonable life expectancy, surgery may be better for greater long-term durability.

19
Q

What is the difference between chronic and acute limb ischamia?

A

Chronic= caused usually by an atheroma in the peripheral arteries and develops over a long perid of time

Acute= Caused by an embolus or a thrombus (NOT A DVT!) and is a medical emergency

20
Q

What % of acute limb ischaemia cases are caused by A) Embolus and B) Thrombus

A

A) 30%

B) 60%

21
Q

What are some of the common causes of acute limb ischaemia

A

Arterial embolus such as MI, AF or proximal atherosclerosis

Thrombus from a previously diseased artery

Trauma

Dissection

Acute aneurism

22
Q

What are the clinical features of acute limb ischaemia? (The 6 P’s)

A
  1. Pain
  2. Pallor
  3. Pulse Deficit
  4. Paraesthesia
  5. Paresis/Paralysis
  6. Poikilothermia (cold)

Compare to contralateral limb

23
Q

When does acute limb ischaemia become irreversible?

A

After 6-8 hours (this is when it is then classed as compartment syndrome)

24
Q

What are the features of compartment syndrome?

A
  • Inflammation
  • Oedema
  • venous obstruction
  • Rise in creatinine kinase
  • Risk of renal failure (myoglobulinaemia)
25
Q

How is acute limb ischaemia managed if it has been caused by an embolus and the limb is still salvageable?

A

Embolectomy

26
Q

How is acute limb ischaemia managed if it has been caused by an thrombus and the limb is still salvageable?

A

Endovascular mechanical thrombectomy or thrombolysis

27
Q

How should a patient with acute limb ischaemia be managed if the limb cannot be salvaged?

A

If possible, amputate, if not palliate

28
Q

What % of diabetic patients will develop a foot ulcer in their lifetime?

A

25%

29
Q

What % of diabetic foot ulcers become infected?

A

50%

30
Q

What % of diabetic foot ulcers result in amputation?

A

20%

31
Q

What 6 factors contribute to the formation of a diabetic foot ulcer?

A
  1. microvascular peripheral artery disease
  2. Peripheral neuropathy
  3. Mechanical imbalance
  4. Foot deformity
  5. Minor trauma
  6. Susceptibility to infection
32
Q

What measures can be taken to avoid the development of a diabetic foot ulcer?

A
  1. Always wear shoes
  2. Check the fit of footwear
  3. Check pressure points and the underside of the foot regularly
  4. Take care of skin breaches on the foot
  5. Control blood sugars!!
33
Q

How is a diabetic foot ulcer managed?

A
  1. Prevention
  2. Careful wound management
  3. Consider systemic antibiotics if there is a possiblity of infection
  4. Investigate for osteomyelitis, gas gangrene, necrotizing fasciitis
  5. Revascularise distal disease
  6. Amputation if appropriate
  7. Dressings
  8. Debridement
  9. Negative pressure wound closure
  10. Skin grafts

Cardiovascular Medicine (24 decks)

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